Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. If you continue browsing the site, you agree to the use of cookies on this website. See our User Agreement and Privacy Policy.

Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. If you continue browsing the site, you agree to the use of cookies on this website. See our Privacy Policy and User Agreement for details.

ADHD: Across the Age Spectrum

2.
Ayni Neuroscience Institute
History of ADHD
ADHD
-William James (1890)
“There is a normal type of
character, for example, in
which impulses seem to
discharge so promptly into
movements that inhibitions
get no time to arise. These
are the ‘dare devil’ and
mercurial temperaments
overflowing with animation
and fizzling with talk.”

3.
Overview
ADHD
Ayni Neuroscience Institute
•What is ADHD?
•Why do we diagnose and treat it?
• How do we diagnosis it?
• How do we treat it?
• Common diagnostic and treatment complications

6.
ADHD Ayni Neuroscience Institute
DSM 5: Criteria for Hyperactivity/Impulsivity
Six or more of the following (only 5 required if over 17yo):
Hyperactivity
• Fidgets with hands or feet or squirms in seat
• Leaves seat/unable to remain seated when expected
• Motor restlessness, often runs about or climbs excessively
• Difficulty playing or engaging in activities quietly
• “on the go” or acts as if “driven by a motor”
• Talks excessively
Impulsivity
• Blurts out answers
• Difficulty waiting turn
• Interrupts or intrudes on others

8.
ADHD Ayni Neuroscience Institute
DSM 5: Additional Criteria for Diagnosis
Symptoms:
• several symptoms were present before 12 yrs of age (prev 7yo)
• result in clear, clinically significant impairment in social, academic,
or occupational functioning
• result in impairment in two or more settings.
• have persisted for at least 6 months
• have been present to a degree that is maladaptive and inconsistent
with developmental levels
• do not occur exclusively during the course of schizophrenia or other
psychotic disorder
• are not better accounted for by another mental disorder
• can specify if Combined, Inattentive, Hyperactive, partial remission

14.
ADHD Ayni Neuroscience Institute
DEVELOPMENTAL COURSE OF ADHD
Preschool
– mean age of onset for H type is 4.21 years
– mean age of onset for C type is 4.88 years
– difficulty sitting still and being read to,
noncompliance, temper tantrums
– parents state they need to child-proof the home,
must provide more supervision, have difficulties
with babysitters and day care settings
– treatment focuses on prevention of injury and
decreasing impulsive aggression

15.
ADHD Ayni Neuroscience Institute
DEVELOPMENTAL COURSE OF ADHD
School Age
• school accentuates problems: high rates of off-task
behaviors, noncompliance, temper tantrums
• at risk for learning/academic problems: 3x more likely to be
retained, often due to being “immature”
• poor social skills; at risk for social rejection
• hyperactive types (98%) and combined types (82%) usually
meet criteria and are impaired by age 7yo
• By late childhood, 30-50% develop sx of conduct disorder
such as fighting, stealing, truancy

16.
ADHD Ayni Neuroscience Institute
DEVELOPMENTAL COURSE OF ADHD
Adolescence
• 50-70% continue to have poor attention, impulse control,
although hyperactivity diminishes
• many inattentive types (20-30%) may not become
impaired and met criteria until middle school
• 30% drop out of high school compared to 10% for
normal controls; 5% of ADHD students go to college vs
41% of normal controls
• increased risk for car accidents, substance abuse, juvenile
delinquency
• 25-35% of ADHD children will be referred to juvenile
court at least one tie

20.
ADHD Ayni Neuroscience Institute
ADHD Comorbidity vs. Mimicry
• ADHD and ODD/CD are highly comorbid, but many children with
ODD/CD don’t have ADHD, don’t let parental frustration sway you
• ADHD and PTSD are moderately comorbid; PTSD can look like
ADHD, but is not present in every setting
• ADHD and BIPOLAR ARE NOT COMORBID, Bipolar is cyclic
and ADHD is constant; they can co-occur, but Bipolar is the priority
• ADHD and substance use are moderately comorbid, but pt needs to be
clean to accurately diagnose ADHD
• ADHD is highly comorbid in Asperger’s, moderate comorbid in
Autism

26.
ADHD Ayni Neuroscience Institute
When to see a Psychiatrist
• Confusing diagnostically or severe co-morbidity (not just ODD)
• Insist upon individual/family therapy for comorbid ODD
• Difficult to manage side effects or failure of both stimulants
• Suspicion of Autism Spectrum d/o, get neuropsych or CDD eval
• Suspicion of Bipolar/CPS or signs of mania or psychosis
• Significant history of substance use with ADHD
• Already seeing a psychiatrist